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Background:The impact of different approaches to fl uid management during intraoperative volume resuscitation in patients undergoing major elective surgery is poorly defi ned. We compared volume effectiveness of crystalloid and colloid substitution aimed to maintain the cardiac index (CI) between 2.6 and 3.8 l/min/ m 2 as measured by transesophageal Doppler (TED). Methods: A total of 115 urological patients were enrolled in the prospective randomized trial and then randomized into 2 groups, one with volume therapy based on crystalloids (n = 57) and the other with colloids (n = 58). A TED probe was inserted and then hemodynamic optimization (therapy with Ringer's solution or hydroxyethyl starch 6 % 130/0.4 and administration of vasoactive drugs) was started according to TED variables to maintain the CI between 2.6 and 3.8 l/min/m 2 . Results: We observed high incidence of CI < 2.6 l/min/m 2 after induction of anesthesia (75 %) in both groups. There were no signifi cant differences in demographic characteristics, ASA classifi cation, length of surgery, estimated blood loss and the CI during surgery. To maintain the CI within the requested interval, signifi cantly different amounts of crystalloids were needed as compared to colloid (median: 5000 ml vs 1500 ml). In the CRY group, more patients were treated by vasodilatators (40.4 vs 20.7 %). Conclusions:The study confi rmed that crystalloids and colloids are effective in correcting fl ow-related perfusion abnormalities. The signifi cant difference between volumes of crystalloids and colloids proved their different characteristics such as unequal distribution between compartments. The expansion of therapeutic algorithm by using vasoactive drugs allows us to avoid adverse events resulting from fl uid overload (Tab. 1, Fig. 5, Ref. 35). Text in PDF www.elis.sk.